Help I'm Bleeding
What is the first and most versatile form of bleeding control, that works on all parts of the body?
Direct pressure!!!
What is blanching?
When the skin becomes white/pale in color
Define indication and contraindication
I: a symptom or reason to give a medication
For example, chest pain is an indication to give aspirin
C/I: A reason why you CANNOT give a medication or intervention.
For example, you cannot give nitroglycerin to a patient who is hypotensive
How many cervical vertebrae are there?
7
What are the 4 mechanisms of heat loss, and list an intervetion for each of them
Evaporation - dry clothes, keep layers dry
Convection - prevent wind chill with a wind break
Conduction - insulate from the cold ground
Radiation - thermal layers to keep heat close to the body
When is it appropriate to cut the clothes from a trauma patient?
To visualize and treat life threats
For example if you find a source of bleeding during the primary assessment you need to cut the clothes away to determine the extent of the injuries and decide how to treat them
Why is splinting an injury with a pillow not the most effective splint?
It is not rigid and does not extend above and below the injury, however it is a quick easy way to provide initial stabilization with a readily available tool
What is an early indication of shock (hypoperfusion)?
Altered Mental Status
Explain each level of the AVPU scale
A - alert, opens eyes and tracks, talking, aware
V- responds to verbal stimuli, "HEY are you OK?"
P - responds to painful stimuli, sternal rub/trap pinch
U - does not respond to pain
How long should you check the pulse for an unconscious patient who has succumbed to hypothermia?
60 seconds, their heart rate can be so low that it will not be palpated in just 10 seconds
What are some signs and symptoms of a pelvic fracture?
- pt is unable to move legs
- crepitus and/or pain on palpation
- signs of shock
- pt may feel the need to empty their bladder
You notice bleeding from an abrasion, what type of vessel is this bleeding likely coming from?
Capillaries
Who can and cannot provide meds through an IV?
Paramedics, Nurses, MPIC on a vessel 200 miles from shore under medical direction
NOT in the EMT scope
What is a flail chest?
A section of the chest wall that is unstable and causes breathing problems
a section of 2 or more ribs broken in 2 or more places
What populations are most at risk for hypothermia in an urban environment?
Homeless, geriatric/pediatric, trauma
What type of injury can cause jugular vein distension (JVD)? What type of shock is likely occuring?
Tension pneumothorax, the air pressure in the chest is compressing the heart and lungs, this causes blood to back up in the veins, causing them to bulge.
Obstructive shock, the air in the pleural space is obstructing perfusion
Why are electrical burns so concerning?
They often cause extensive internal injuries, beyond what is visible on the surface
When is a heparin or saline lock used in IV admin?
When meds or IV access might be needed later on
What happens to the brain if it continues swelling beyond the volume of the skull?
It will herniate through the foramen magnum, an opening at the base of the skull
You come across a patient who is violently shivering, what stage of hypothermia are they in?
Mild or Moderate, NOT severe. As hypothermia progresses, the body stops shivering and producing heat
Your patient has a penetrating chest injury, you treat with an occlusive dressing and supplemental oxygen. If they have normal vitals and are otherwise asymptomatic, do they still need to be transported rapidly?
Yes - we have no way of knowing the extent of life threatening internal injuries, penetrating trauma to the chest is always rapid evac criteria
When should you realign a deformed musculoskeletal injury?
Only if there is a loss of CSM distal to the injury, you can gently reposition the break before splinting.
DO NOT realign if you meet resistance or if it is severely painful
What is commotio cordis and when would we expect to see it?
a rare, often fatal cardiac arrest triggered by a blunt, non-penetrating blow to the chest directly over the heart, typically during sports
You arrive on scene to an patient who has fallen from >2x their body height, they are pale and have an open fracture of their leg, what is the sequence of your interaction?
1. manually stabilize the C spine
2. primary assessment
3. apply oxygen
4. perform a rapid physical exam
5. immobilize on backboard
6. transport
7. splint leg and get SAMPLE history during transport if time allows
How should we prevent afterdrop in a patient with hypothermia and why is afterdrop dangerous?
Afterdrop is the sensation of cold blood from the extremities rushing to the heart, this can cause arrythmias such as ventricular fibrillation